颅脑外科深静脉血栓形成的预见性护理措施与方法

探讨颅脑外科深静脉血栓形成的预见性护理措施与方法,分析其临床使用和推广的价值。选取颅脑外科患者88例,按照随机数字表法分为观察组和对照组,观察组采用预见性护理措施和方法进行护理,对照组采用常规护理方法进行护理。通过两组深静脉血栓的例数和形成率比较两组的护理效果。观察组深静脉血栓形成率为4.5%,对照组为31.8%,观察组深静脉血栓的形成率明显低于对照组,差异具有统计学意义(P<0.05)。对颅脑外科患者采用预见性护理措施与护理方法能降低深静脉血栓的形成,促进患者的康复,具有临床应用和推广价值。     

早期护理干预对下肢骨折术后深静脉血栓形成的影响

目的 探讨早期护理干预对下肢骨折术后深静脉血栓形成的影响.方法 将100例下肢骨折术后患者随机分为实验组和对照组各50例,对照组给予常规护理,实验组在此基础上进行系统的护理干预.结果护理干预组较对照组发生下肢静脉血栓明显减少,两组比较差异有显著性(P＜0.01).结论早期护理干预能有效降低下肢骨折术后深静脉血栓形成的发生率.     

预见性护理对预防下肢静脉曲张术后深静脉血栓形成的影响

目的探讨预见性护理干预在下肢静脉曲张患者术后预防下肢深静脉血栓形成中的作用。方法将2013~2015年本科手术患者276例随机分为实验组和对照组,每组138例,对照组患者行常规护理,实验组患者行预见性护理干预,采用Wells系统评分,据Wells评分对患者进行下肢深静脉血栓形成风险进行分层,低风险<0分、中风险1~2分、高风险大于等于3分。并以Wells评分为依据,对患者作预防性抗凝治疗。对比2组患者的DVT发生率、护理质量的满意度。结果本研究276例患者中,2组患者中Wells评分分布无统计学差异,两组均以3分以上患者居多,实验组占46.8%,对照组46.2%,实验组未发生下肢深静脉血栓形成病例,对照组出现下肢深静脉血栓形成病例4例(2.9%)。2组深静脉血栓形成率比较差异较大,差异有统计学意义(P<0.05)。结论应用预见性护理干预能够有效预防下肢静脉曲张患者术后深静脉血栓形成,提高护理质量的满意度,值得临床推广应用。     

早期护理干预预防脑出血手术患者下肢深静脉血栓形成的效果

目的 探讨早期护理干预预防脑出血术后患者下肢深静脉血栓形成的效果.方法 将60例脑出血手术患者随机分为实验组和对照组,各30例,实验组在术前和术后给予早期护理干预,对照组给予常规护理.比较两组效果.结果 实验组患者脑出血术后下肢深静脉血栓形成较对照组明显减少,两组比较差异有统计学意义（x2=5.192,P=0.023）.结论 早期护理干预能降低脑出血手术患者术后下肢深静脉血栓的形成.该方法简单、安全、经济,且疗效迅速,值得临床推广应用.     

早期护理干预对老年消化道肿瘤术后下肢深静脉血栓形成的影响

目的探讨早期护理干预对老年消化道肿瘤术后下肢深静脉血栓形成的影响。方法选择我科2009年4月～2012年4月收治消化道肿瘤病人322例,随机分为实验组和对照组,各161例。对照组实施传统胃肠道手术常规护理;实验组在常规护理的基础上实施早期护理干预。结果实验组下肢深静脉血栓形成发生率为2.48%,未见肺栓塞与死亡病例。对照组下肢深静脉血栓形成发生率为16.77%,肺栓塞发生率为3.11%,死亡率为1.24%。两组比较有显著性差异(P<0.05)。结论实施早期护理干预措施,能使病人掌握并运用下肢深静脉血栓形成的相关知识,积极主动地配合治疗,有效降低术后下肢深静脉血栓形成的发生率和死亡率。     

预见性护理干预在高血压脑出血急性期患者下肢深静脉血栓形成中的应用

目的 探析预见性护理干预对高血压脑出血急性期患者下肢深静脉血栓形成的影响.方法 选取2022年3月至2022年12月我院神经内科收治的高血压脑出血急性期患者56例作为研究对象.随机将患者分为对照组和观察组,每组各28例.对照组予以常规护理干预,观察组予以预见性护理干预.分析比较两组的下肢深静脉血栓形成、疼痛程度与双侧肢体周径差、凝血指标.结果 观察组干预后下肢深静脉血栓形成显著少于对照组(P<0.05).观察组干预后疼痛程度显著轻于对照组,双侧肢体周径差显著小于对照组(P<0.05).观察组干预后的APT     

早期护理干预在预防肿瘤重症病人深静脉血栓中的应用

[目的]探讨早期护理干预对预防肿瘤重症病人深静脉血栓的效果。[方法]将145例肿瘤重症病人分为对照组70例和实验组75例,对照组病人采用重症监护室（ICU）常规护理,实验组在ICU常规护理的基础上行早期评估、行为训练、物理治疗等早期护理干预。每隔14d采用多普勒超声检查有无深静脉血栓的形成,比较两组病人深静脉血栓发生率。[结果]实验组病人中有5例发现深静脉血栓,对照组病人中有13例发现深静脉血栓,差异具有统计学意义（P〈0．05）。[结论]早期护理干预能有效预防肿瘤重症病人深静脉血栓形成。     

老年全髋关节置换术后下肢深静脉血栓预防的综合护理干预

目的 探讨老年患者人工全髋关节置换术后深静脉血栓形成的护理干预与对策.方法 129例人工全髋关节置.换术后老年患者随机分为实验组(65例)和对照组64例.对照组给予基本预防护理,只给予一般护理措施、药物预防措施和心理支持;于预组在常规护理的基础上,针对发病原因实施如下预见性术后DVT综合护理干预措施.结果 与对照组相比,实验组老年全髋关节置换术后患者经综合护理后继发深静脉血栓为2例明显减少,DVT发生率(3.08％)明显低于对照组(21.88％)(P＜0.05).结论 对老年患者人工全髋关节置换术后施以有效的综合护理措施,可以降低静脉血栓栓塞症的风险.     

预防性护理在颅脑外科患者深静脉血栓形成中的应用

目的:探讨颅脑外科患者深静脉血栓形成的预防性护理效果。方法:选择2012年3月~2014年3月我院收治的240例颅脑外科术后患者作为研究对象,随机等分为试验组和对照组,试验组给予预防性护理干预,对照组给予常规护理,比较两组胭静脉和胭静脉流速。结果:两组相比股静脉和胭静脉血流速度,差异有统计学意义(均P0.05)。结论:预防性干预措施应用于颅脑外科术后患者,对于降低深静脉血栓形成具有积极意义,值得临床考虑。     

全程预见性护理服务链在高危下肢深静脉血栓产妇中的应用研究

目的：探讨全程预见性护理服务链在高危下肢深静脉血栓产妇中的应用效果。方法选取全程预见性护理服务链实施前(2015年10~12月)和实施后(2016年1月~3月)收治于本院具备下肢深静脉血栓高危风险因素的产妇各51例为研究对象,随机分为对照组和实验组。对照组接受常规下肢深静脉血栓预防干预,实验组接受针对下肢深静脉血栓的全程预见性护理服务链干预,对两组观察对象干预后各相关指标的差异性进行观察比较。结果实验组入选产妇干预后发生下肢深静脉血栓的比例及临床症状积分显著低于对照组产妇,对专项血栓预防性护理服务的满意率则显著高于对照组产妇,差异具有统计学意义( P<0.05)。结论采用全程预见性护理服务链对高危下肢深静脉血栓产妇实施干预,降低了该类产妇下肢深静脉血栓发生的可能性,减轻了相关症状,获得了较高的护理满意率。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.